Perineural invasion in cancer: A review of the literature

Catherine Liebig, Gustavo Ayala, Jonathan A. Wilks, David H. Berger, Daniel Albo

Research output: Contribution to journalReview articlepeer-review

826 Scopus citations


Perineural invasion (PNI) is the process of neoplastic invasion of nerves and is an under-recognized route of metastatic spread. It is emerging as an important pathologic feature of many malignancies, including those of the pancreas, colon and rectum, prostate, head and neck, biliary tract, and stomach. For many of these malignancies, PNI is a marker of poor outcome and a harbinger of decreased survival. PNI is a distinct pathologic entity that can be observed in the absence of lymphatic or vascular invasion. It can be a source of distant tumor spread well beyond the extent of any local invasion; and, for some tumors, PNI may be the sole route of metastatic spread. Despite increasing recognition of this metastatic process, there has been little progress in the understanding of molecular mechanisms behind PNI and, to date, no targeted treatment modalities aimed at this pathologic entity. The objectives of this review were to lay out a clear definition of PNI to highlight its significance in those malignancies in which it has been studied best. The authors also summarized current theories on the molecular mediators and pathogenesis of PNI and introduced current research models that are leading to advancements in the understanding of this metastatic process.

Original languageEnglish (US)
Pages (from-to)3379-3391
Number of pages13
Issue number15
StatePublished - Aug 1 2009
Externally publishedYes


  • Axon guidance molecule
  • Cancer
  • Neurotrophins
  • Neurotropic carcinoma
  • Perineural invasion
  • Perineural spread

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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